Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Thyroid. 2010 Jan;20(1):25-31. doi: 10.1089/thy.2009.0208.
The preoperative diagnosis of malignancy in nodules suspicious for a follicular neoplasm remains challenging. A number of clinical and cytological parameters have been previously studied; however, none have significantly impacted clinical practice. The aim of this study was to determine predictive characteristics of follicular neoplasms useful for clinical application.
Four clinical (age, sex, nodule size, solitary nodule) and 17 cytological variables were retrospectively reviewed for 144 patients with a nodule suspicious for follicular neoplasm, diagnosed preoperatively by fine-needle aspiration (FNA), from a single institution over a 2-year period (January 2006 to December 2007). The FNAs were examined by a single, blinded pathologist and compared with final surgical pathology. Significance of clinical and cytological variables was determined by univariate analysis and backward stepwise logistic regression. Odds ratios (ORs) for malignancy, a receiver operating characteristic curve, and predicted probabilities of combined features were determined.
There was an 11% incidence of malignancy (16/144). On univariate analysis, nodule size >OR=4.0 cm nears significance (p = 0.054) and 9 of 17 cytological features examined were significantly associated with malignancy. Three variables stay in the final model after performing backward stepwise selection in logistic regression: nodule size (OR = 0.25, p = 0.05), presence of a transgressing vessel (OR = 23, p < 0.0001), and nuclear grooves (OR = 4.3, p = 0.03). The predicted probability of malignancy was 88.4% with the presence of all three variables on preoperative FNA. When the two papillary carcinomas were excluded from the analysis, the presence of nuclear grooves was no longer significant, and anisokaryosis (OR = 12.74, p = 0.005) and presence of nucleolus (OR = 0.11, p = 0.04) were significantly associated with malignancy. Excluding the two papillary thyroid carcinomas, a nodule size >or=4 cm, with a transgressing vessel and anisokaryosis and lacking a nucleolus, has a predicted probability of malignancy of 96.5%.
A combination of larger nodule size, transgressing vessels, and specific nuclear features are predictive of malignancy in patients with follicular neoplasms. These findings enhance our current limited predictive armamentarium and can be used to guide surgical decision making. Further study may result in the inclusion of these variables to the systematic evaluation of follicular neoplasms.
术前诊断滤泡性肿瘤可疑结节中的恶性肿瘤仍然具有挑战性。已经研究了许多临床和细胞学参数；然而，没有一个参数对临床实践产生了重大影响。本研究的目的是确定用于临床应用的滤泡性肿瘤的预测特征。
回顾性分析了 144 例在单个机构中经细针抽吸（FNA）术前诊断为滤泡性肿瘤可疑结节的患者的 4 个临床（年龄、性别、结节大小、单发结节）和 17 个细胞学变量，时间为 2 年（2006 年 1 月至 2007 年 12 月）。由一位经验丰富的病理学家对 FNA 进行了检查，并与最终的手术病理进行了比较。通过单变量分析和向后逐步逻辑回归确定临床和细胞学变量的意义。确定了恶性肿瘤的优势比（OR）、受试者工作特征曲线和组合特征的预测概率。
恶性肿瘤的发生率为 11%（16/144）。单变量分析显示，结节大小>OR=4.0cm 有显著意义（p=0.054），17 项细胞学特征中有 9 项与恶性肿瘤显著相关。在逻辑回归的向后逐步选择后，有 3 个变量进入最终模型：结节大小（OR=0.25，p=0.05）、存在侵犯性血管（OR=23，p<0.0001）和核沟（OR=4.3，p=0.03）。术前 FNA 存在所有三个变量时，恶性肿瘤的预测概率为 88.4%。将两例甲状腺乳头状癌排除在分析之外后，核沟的存在不再具有统计学意义，核异质性（OR=12.74，p=0.005）和核仁存在（OR=0.11，p=0.04）与恶性肿瘤显著相关。排除两例甲状腺乳头状癌后，结节大小>or=4cm，存在侵犯性血管和核异质性，缺乏核仁的患者，恶性肿瘤的预测概率为 96.5%。
较大的结节大小、侵犯性血管和特定的核特征的组合可预测滤泡性肿瘤患者的恶性肿瘤。这些发现增强了我们目前有限的预测工具，并可用于指导手术决策。进一步的研究可能会导致将这些变量纳入滤泡性肿瘤的系统评估。
